BILL ANALYSIS                                                                                                                                                                                                    




          Appropriations Committee Fiscal Summary

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|                               |SB 559  (Brulte)            |
|-------------------------------+----------------------------|
|                               |                            |
|-------------------------------+----------------------------|
|Hearing Date: 5/27/99          |Amended: As introduced      |
|-------------------------------+----------------------------|
|Consultant: David              |Policy Vote: Insurance 8-0  |
|Maxwell-Jolly                  |                            |
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BILL SUMMARY:  SB 559 prohibits a payor from paying a  
health care provider a preferred or discounted rate unless  
the payor meets all the following conditions:
 The payor has an agreement with the provider regarding  
  the preferred rate
 The preferred rate applies only to claims for  
  beneficiaries that get some benefit from using the  
  preferred provider.
 The provider is given notice and has an opportunity to  
  decline to participate.
The preferred rates can only apply prospectively to  
services rendered after the effective date of the  
agreement.  The payor must provides an explanation of the  
benefits that identifies the specific preferred rate  
agreement that is governing the rates paid.  The bill gives  
a health care provider legal recourse to collect standard  
reasonable charges, paying at least $500 or twice the  
standard amount, plus attorneys fees and costs. 
                         Fiscal Impact (in thousands)
  
Major Provisions    1999-2000     2000-01      2001-02      Fund  

State employee and 
 retiree health benefits          unknown potential cost increasesGeneral &
                                                     others 

STAFF COMMENTS:  

SUSPENSE FILE

PERS believes that the bill is unlikely to have any  
significant cost for the state.










 
Payors in this case include HMOs, specialized health care  
service plans, health insurers, worker's compensation  
insurers, employers or any other third party that pays for  
health care services for beneficiaries.

The sponsors state that this bill is needed to protect  
health care providers from being forced to grant billing  
discounts, without their knowledge or consent, to insurance  
entities with whom the provider has no direct contractual  
relationship.       The cosponsors believe the bill is  
necessary because some health care service plans and other  
insurance entities are "selling" their provider lists to  
gain     additional revenue and that this "doctor selling"  
is becoming more commonplace. 

Payors are concerned with the complex disclosure, billings,  
and other administrative burdens imposed by the bill.